BPSRES ;BHAM ISC/BEE - ECME SCREEN RESUBMIT W/EDITS ;19-MAY-06 ;;1.0;E CLAIMS MGMT ENGINE;**3,5**;JUN 2004;Build 45 ;;Per VHA Directive 2004-038, this routine should not be modified. ; Q ; ;ECME Resubmit w/EDITS Protocol (Hidden) - Called by [BPS USER SCREEN] ; RESED N BPSEL ; I '$D(@(VALMAR)) G XRESED D FULL^VALM1 ; ;Select the claim to resubmit W !,"Enter the line number for the claim to be resubmitted." S BPSEL=$$ASKLINE("Select item","Please select a SINGLE claim only when using the Resubmit w/EDITS action option.") I BPSEL<1 S VALMBCK="R" G XRESED ; ;Attempt to resubmit the claim, update the content of the screen, and display ;only if claim submitted successfully I $$DOSELCTD(BPSEL) D REDRAW^BPSSCRUD("Updating screen for resubmitted claim...") E S VALMBCK="R" ; XRESED Q ; ;Attempt to Edit and Resubmit Selected Claim ; ; Input Value -> BPRXI - Entry with ptr to BPS TRANSACTION file ; ; Return Value -> 0 - Claim was not resubmitted ; 1 - Claim was resubmitted ; DOSELCTD(BPRXI) N BP02,BP59,BPBILL,BPCLTOT,BPDFN,BPDOSDT,BPOVRIEN,BPQ,BPRXIEN,BPRXR,BPSTATUS,BPUPDFLG S (BPQ)="" S (BPCLTOT,BPUPDFLG)=0 ; ;Pull BPS TRANSACTION/BPS CLAIMS entries S BP59=$P(BPRXI,U,4) I BP59="" W !!,"No Initial Claim Submission Found - Data Elements are NOT Editable for Re-Submission",! G XRES S BP02=+$P($G(^BPST(BP59,0)),U,4) I 'BP02 W !!,"No Initial Claim Submission Found - Data Elements are NOT Editable for Re-Submission",! G XRES ; ;Write Form Feed W @IOF ; ;Display selected claim and ask to submit S BPDFN=+$P($G(^BPST(BP59,0)),U,6) W !,"You've chosen to RESUBMIT the following prescription for "_$E($$PATNAME^BPSSCRU2(BPDFN),1,13) W !,@VALMAR@(+$P(BPRXI,U,5),0) S BPQ=$$YESNO^BPSSCRRS("Are you sure?(Y/N)") I BPQ'=1 S BPQ="^" G XRES ; ;Check to make sure claim can be Resubmitted w/EDITS S BPRXIEN=$P(BP59,".") S BPRXR=+$E($P(BP59,".",2),1,4) I $$RXDEL^BPSOS($P(BP59,".",1),+$E($P(BP59,".",2),1,4)) W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"cannot be Resubmitted w/EDITS because it has been deleted in Pharmacy.",! G XRES S BPSTATUS=$P($$CLAIMST^BPSSCRU3(BP59),U) I BPSTATUS["IN PROGRESS" W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"is still In Progress and cannot be Resubmitted w/EDITS",! G XRES I BPSTATUS'["E REJECTED" W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"is NOT Rejected and cannot be Resubmitted w/EDITS",! G XRES ; ;Prompt for EDIT Information S BPOVRIEN=$$PROMPTS(BP59,BP02) I BPOVRIEN=-1 G XRES ; ;Retrieve DOS S BPDOSDT=$$DOSDATE^BPSSCRRS(BPRXIEN,BPRXR) ; ;Resubmit Claim S BPBILL=$$EN^BPSNCPDP(BPRXIEN,BPRXR,BPDOSDT,"ERES","","ECME RESUBMIT","",BPOVRIEN) ; ;Print Return Value Message W !! W:+BPBILL>0 $S(+BPBILL=10:"Reversal but no Resubmit:",1:"Not Processed:"),!," " ; ;Change Return Message for SC/EI S:$P(BPBILL,U,2)="NEEDS SC DETERMINATION" $P(BPBILL,U,2)="NEEDS SC/EI DETERMINATION" W $P(BPBILL,U,2) ; ;0 Prescription/Fill successfully submitted to ECME ;1 ECME did not submit prescription/fill ;2 IB says prescription/fill is not ECME billable or the data returned from IB is not valid ;3 ECME closed the claim but did not submit it to the payer ;4 Unable to queue the ECME claim ;5 Invalid input ;10 Reversal Processed But Claim Was Not Resubmitted ; I +BPBILL=0 D . D ECMEACT^PSOBPSU1(+BPRXIEN,+BPRXR,"Claim resubmitted to 3rd party payer: ECME USER's SCREEN") . S BPUPDFLG=1,BPCLTOT=1 XRES I BPCLTOT W !,BPCLTOT," claim",$S(BPCLTOT'=1:"s have",1:" has")," been resubmitted.",! D PAUSE^VALM1 Q BPUPDFLG ; ;Enter EDIT information for claim ; ; Input Values -> BP59 - The BPS TRANSACTION entry ; BP02 - The BPS CLAIMS entry ; Output Value -> BPQ - -1 - The user chose to quit ; "" - The user completed the EDITS PROMPTS(BP59,BP02) N %,BP300,BPCLCD,BPFDA,BPFLD,BPOVRIEN,BPMED,BPMSG,BPPSNCD,BPPREAUT,BPPRETYP,BPQ,BPRELCD,DIC,DIR,DIROUT,DTOUT,DUOUT,X,Y ; S BPQ="" ; ;Pull Information from Claim S BP300=$G(^BPSC(BP02,300)) S BPRELCD=$TR($E($P(BP300,U,6),3,99)," ") S BPPSNCD=$TR($E($P(BP300,U,3),3,99)," ") S (BPPRETYP,BPPREAUT,BPCLCD)="",BPMED=0 F S BPMED=$O(^BPSC(BP02,400,BPMED)) Q:'BPMED D I BPPREAUT]"",BPCLCD]"" Q .N BP460 S BP460=$G(^BPSC(BP02,400,BPMED,460)) .S:BPPREAUT="" BPPREAUT=$TR($E($P(BP460,U,2),3,99)," "),BPPRETYP=$TR($E($P(BP460,U),3,99)," ") .S:BPCLCD="" BPCLCD=$TR($E($P($G(^BPSC(BP02,400,BPMED,400)),U,20),3,99)," ") ; W ! S DIR(0)="FO^1:1",DIR("A")="Relationship Code" S DIR("B")=BPRELCD K DIR("?") S DIR("?",1)="Select the relationship code that describes the relationship this patient has" S DIR("?",2)="to the holder of this insurance policy. The standard NCPDP Patient" S DIR("?",3)="Relationship Code list is shown below. However, it is important to note" S DIR("?",4)="that some payers use their own set of codes for this field so the field" S DIR("?",5)="should be populated based upon the payer's expectations." S DIR("?",6)=" " S DIR("?",7)="Choose from:" S DIR("?",8)=" 0 Not Specified" S DIR("?",9)=" 1 Cardholder" S DIR("?",10)=" 2 Spouse" S DIR("?",11)=" 3 Child" S DIR("?")=" 4 Other" D ^DIR I $G(DTOUT)!$G(DUOUT) S BPQ=-1 G XPROMPTS S BPRELCD=Y ; ;Person Code K DIR("?") S DIR(0)="FO^1:3",DIR("A")="Person Code",DIR("?")="Enter the Specific Person Code Assigned to the Patient by the Payer" S DIR("B")=BPPSNCD D ^DIR I $G(DTOUT)!$G(DUOUT) S BPQ=-1 G XPROMPTS S BPPSNCD=Y ; ;Pre-Authorization K DIR("?") S DIR(0)="FO^1:11",DIR("A")="Prior Authorization Number",DIR("?")="Enter the Number Submitted by the Provider to Identify the Prior Authorization" S DIR("B")=BPPREAUT D ^DIR I $G(DTOUT)!$G(DUOUT) S BPQ=-1 G XPROMPTS S BPPREAUT=Y ; ;Prior-Authorization Type Code N X,DIC,Y S DIC("B")=+BPPRETYP S DIC(0)="QEAM",DIC=9002313.82461,DIC("A")="Prior Authorization Type Code: " D ^DIC ; ;Check for "^" or timeout I ($G(DUOUT)=1)!($G(DTOUT)=1)!(Y=-1) S BPQ=-1 K X,DIC,Y G XPROMPTS S BPPRETYP=$P(Y,U,2) K X,DIC,Y ; ;Submission Clarification Code N X,DIC,Y S DIC("B")=+BPCLCD S DIC(0)="QEAM",DIC=9002313.8242,DIC("A")="Submission Clarification Code: " D ^DIC ; ;Check for "^" or timeout I ($G(DUOUT)=1)!($G(DTOUT)=1)!(Y=-1) S BPQ=-1 K X,DIC,Y G XPROMPTS S BPCLCD=$P(Y,U,2) K X,DIC,Y ; ;Ask to proceed W ! S BPQ=$$YESNO^BPSSCRRS("Are you sure?(Y/N)") I BPQ'=1 S BPQ=-1 G XPROMPTS ; ;Save into BPS NCPDP OVERRIDES (#9002313.511) S BPFDA(9002313.511,"+1,",.01)=BP59 D NOW^%DTC S BPFDA(9002313.511,"+1,",.02)=% S BPFLD=$O(^BPSF(9002313.91,"B",303,"")) I BPFLD]"" S BPFDA(9002313.5111,"+2,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+2,+1,",.02)=BPPSNCD S BPFLD=$O(^BPSF(9002313.91,"B",306,"")) I BPFLD]"" S BPFDA(9002313.5111,"+3,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+3,+1,",.02)=BPRELCD S BPFLD=$O(^BPSF(9002313.91,"B",462,"")) I BPFLD]"" S BPFDA(9002313.5111,"+4,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+4,+1,",.02)=BPPREAUT S BPFLD=$O(^BPSF(9002313.91,"B",461,"")) I BPFLD]"" S BPFDA(9002313.5111,"+5,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+5,+1,",.02)=BPPRETYP S BPFLD=$O(^BPSF(9002313.91,"B",420,"")) I BPFLD]"" S BPFDA(9002313.5111,"+6,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+6,+1,",.02)=BPCLCD D UPDATE^DIE("","BPFDA","BPOVRIEN","BPMSG") ; I $D(BPMSG("DIERR")) W !!,"Could Not Save Override information into BPS NCPDP OVERRIDES FILES",! S BPQ=-1 G XPROMPTS ; XPROMPTS S BPOVRIEN=$S(BPQ=-1:BPQ,$G(BPOVRIEN(1))]"":BPOVRIEN(1),1:-1) Q BPOVRIEN ; ;Prompt User for Claim to Resubmit (w/EDITS) ; ; Input values -> BPROMPT - prompt string ; BPERRMES - the message to display when the user tries ; to make multi line selection (optional) ; Piece ;output values -> 1 - 1 = okay, <0 = errors, 0 = quit ; 2 - patient ien #2 ; 3 - insurance ien #36 ; 4 - ptr to #9002313.59 ; 5 - 1st line for index(es) in LM "VALM" array ; 6 - patient's index ; 7 - claim's index ASKLINE(BPROMPT,BPERRMES) ; N BPRET,BPCNT S BPRET="",BPCNT=0 F S BPRET=$$SELLINE^BPSSCRU4(BPROMPT,"C",VALMAR,"") Q:BPRET'<0 D . ; . I BPCNT<1 S BPCNT=BPCNT+1 W ! . E S BPCNT=0 D RE^VALM4 . I BPRET=-1 W "Invalid line number" ; (invalid Patient summary line)" . I BPRET=-8 W $S($G(BPERRMES)]"":BPERRMES,1:" Invalid line number") . I BPRET=-4 W "Invalid line number" ; (invalid RX line)" . I BPRET=-2 W "Please select Patient's summary line." . I BPRET=-3 W "Please specify RX line." . I ",-1,-8,-4,-2,-3,"'[(","_BPRET_",") W "Incorrect format." ; Corrupted array (",BPRET,")" Q BPRET